Aim Spontaneous rupture of sac of hernia is a less common complication and mainly associated to persistent ascites or congenital wall defects. In literature we have few cases of spontaneous bowel eviscerations in umbilical hernias. Case Report a 53-year-old male years old man addicted to heroin, cocaine and alcohol, presented to the Emergency Department with evisceration of small bowel through an existing umbilical hernia. The patient was conscious and not complaining pain. He stated a protrusion of small bowel through his umbilical skin caused to sudden coughing after assumption of a dose of heroin.In emergency room showed an ileal loop with sub ischemic features. Blood test revealed an hepatitis C infection. During the urgent laparotomy there wasn't evidence of ascites and was necessary to performed an ileal resection and latero-lateral anastomosis with mechanical suturing machine. The placement of a prosthesis was performed; therefore, direct plastic surgery of the abdominal wall. After surgery with a short stay in ICU of 24 hours, the patient was discharged in POD 5. The postoperative course was regular without wound complications. After four months he was free from recurrence and VAS was 0. Conclusions Spontaneous bowel eviscerations in umbilical hernias is associated with refractory ascites in cirrhotic patients or congenital defect. This case is one of few case depicted in literature as spontaneous evisceration of bowel in non cirrhotic patient with umbilical hernia.

Aim A retrospective study was carried out on patients treated for bilateral inguinal hernia with TAPP technique by the department of Urgency Surgery and Transplantation of Varese's hospital in order to investigate the VAS one month after surgery and functional recovery in two groups of patients. Material and Methods 38 patients treated in the last year were enrolled, dividing them in two groups: those who received a single fixing material (reabsorbable clips) and those with a double fixing material (reabsorbable clips and glue). Primary end point was the post-operative pain using the VAS scale at one month. Secondary end-point was the return to daily activities and work in days. The Mann-Whitney test with p-value set< 0.05 was used. Results The single fixing material group shown a 1-month VAS of 0.57 ±1, versus 1.43±4 of the second group (p-value<0.05); with a return of daily activities in 4.92± 8 days, versus 8.06 ± 11 days (p-value<0.05). In addition, analyzing the subpopulation of still active workers (28 of the 38 patient), it was assessed the working back timing. The positioning of only reabsorbable clips, compared with a double fixing material, ensured a faster return to work in 8.2 ±10 days versus 20 ± 30 days (p-value<0.05). Conclusions Fixing the prosthetic mesh with resorbable clips alone, could lead to a more rapid resumption of daily and work activities, with less pain one month after surgery.